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Incidence,characteristics and risk factors for alveolar recruitment maneuver-related hypotension in patients undergoing laparoscopic colorectal cancer resection
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作者 Nan-Rong Zhang Zhi-Nan Zheng +1 位作者 Kai Wang Hong Li 《World Journal of Gastrointestinal Surgery》 SCIE 2023年第7期1454-1464,共11页
BACKGROUND Alveolar recruitment maneuvers(ARMs)may lead to transient hypotension,but the clinical characteristics of this induced hypotension are poorly understood.We investigated the characteristics of ARM-related hy... BACKGROUND Alveolar recruitment maneuvers(ARMs)may lead to transient hypotension,but the clinical characteristics of this induced hypotension are poorly understood.We investigated the characteristics of ARM-related hypotension in patients who underwent laparoscopic colorectal cancer resection.AIM To investigate the characteristics of ARM-related hypotension in patients who underwent laparoscopic colorectal cancer resection.METHODS This was a secondary analysis of the PROtective Ventilation using Open Lung approach Or Not trial and included 140 subjects.An ARM was repeated every 30 min during intraoperative mechanical ventilation.The primary endpoint was ARM-related hypotension,defined as a mean arterial pressure(MAP)<60 mmHg during an ARM or within 5 min after an ARM.The risk factors for hypotension were identified.The peri-ARM changes in blood pressure were analyzed for the first three ARMs(ARM_(1,2,3))and the last ARM(ARMl_(ast)).RESULTS Thirty-four subjects(24.3%)developed ARM-related hypotension.Of all 1027 ARMs,37(3.61%)induced hypotension.More ARMs under nonpneumoperitoneum(33/349,9.46%)than under pneumoperitoneum conditions(4/678,0.59%)induced hypotension(P<0.01).The incidence of hypotension was higher at ARM_(1)points than at non-ARM_(1)points(18/135,13.3%vs 19/892,2.1%;P<0.01).The median percentage decrease in the MAP at ARM1 was 14%.Age≥74 years,blood loss≥150 mL and peak inspiratory pressure under pneumoperitoneum<24 cm H_(2)O were risk factors for ARM-related hypotension.CONCLUSION When the ARM was repeated intraoperatively,a quarter of subjects developed ARM-related hypotension,but only 3.61%of ARMs induced hypotension.ARM-related hypotension most occurred in a hemodynamically unstable state or a hypovolemic state,and in elderly subjects.Fortunately,ARMs that were performed under pneumoperitoneum conditions had less impact on blood pressure. 展开更多
关键词 Alveolar recruitment maneuvers HYPOTENSION laparoscopic colorectal cancer resection
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Has the open surgical approach in colorectal cancer really become uncommon?
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作者 Maria Cariati Giuseppe Brisinda Maria Michela Chiarello 《World Journal of Gastrointestinal Surgery》 SCIE 2024年第6期1485-1492,共8页
Colorectal cancer is the third most common cancer in the world.Surgery is man-datory to treat patients with colorectal cancer.Can colorectal cancer be treated in laparoscopy?Scientific literature has validated the onc... Colorectal cancer is the third most common cancer in the world.Surgery is man-datory to treat patients with colorectal cancer.Can colorectal cancer be treated in laparoscopy?Scientific literature has validated the oncological quality of laparo-scopic approach for the treatment of patients with colorectal cancer.Randomized non-inferiority trials with good remote control have answered positively to this long-debated question.Early as 1994,first publications demonstrated technical feasibility and compliance with oncological imperatives and,as far as short-term outcomes are concerned,there is no difference in terms of mortality and post-operative morbidity between open and minimally invasive surgical approaches,but only longer operating times at the beginning of the experience.Subsequently,from 2007 onwards,long-term results were published that demonstrated the ab-sence of a significant difference regarding overall survival,disease-free survival,quality of life,local and distant recurrence rates between open and minimally in-vasive surgery.In this editorial,we aim to summarize the clinical and technical aspects which,even today,make the use of open surgery relevant and necessary in the treatment of patients with colorectal cancer. 展开更多
关键词 colorectal cancer LAPAROSCOPY laparoscopic colorectal resection Bowel obstruction Bowel perforation Advanced colorectal cancer
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